Johns F R, Strollo P J, Buckley M, Constantino J
Department of Oral and Maxillofacial Surgery, University of Pittsburgh Medical Center, PA, USA.
J Oral Maxillofac Surg. 1998 May;56(5):596-602; discussion 602-3. doi: 10.1016/s0278-2391(98)90459-1.
This study compares craniofacial measurements of lateral cephalometric radiographs of young obstructive sleep apnea patients with those of nonapneic snorers and controls.
Forty-eight patients (BM=28.0+/-3.8) with obstructive sleep apnea, 25 patients (BMI=26.3+/-3.5) with nonapneic snoring, and 54 controls (BMI=24.8+/-2.7) were evaluated. All subjects were between 18 and 40 years of age. Nineteen lateral cephalometric measurements were performed by a single investigator blinded to the results of the polysomnograms.
Univariate logistic regression analysis of the 19 variables showed significantly increased midfacial height (ANS-N), narrowed middle airway space (MAS), steep mandibular plane angle (FMA), elongated pharynx (PNS-Eb), and inferiorly positioned hyoid bone (PNS-H, MP-H) in the obstructive sleep apnea group. The nonapneic snoring group showed only a tendency toward maxillary and mandibular retrognathia (SNA and SNB). No significant differences were found for cranial base angle (S-N-Ba), PAS, inferior airway space, maxillary unit length (ANS-PNS) mandibular unit length (Cd-Gn), tongue height (Tng-Ht), soft palate length (PNS-P), and palatal vault height (Ocl-Pal 6). The OSA group was also found to have multiple sites of abnormality of both the upper and lower pharynx, with 58% of the patients having two or more abnormal values (1 standard deviation from the mean) as opposed to 40% of the nonapneic snoring group.
Highly significant craniofacial abnormalities were found in the upper and lower pharynx in young obstructive sleep apnea patients. Most of these patients (58%) had abnormalities in both the upper and lower pharynx, suggesting that palatal surgery alone may be an inadequate treatment. This information may define future investigations needed to determine how to more effectively treat this subgroup of young obstructive sleep apnea patients.
本研究比较年轻阻塞性睡眠呼吸暂停患者与非呼吸暂停性打鼾者及对照组的头颅侧位X线片的颅面测量结果。
对48例阻塞性睡眠呼吸暂停患者（体重指数[BMI]=28.0±3.8）、25例非呼吸暂停性打鼾患者（BMI=26.3±3.5）和54例对照组（BMI=24.8±2.7）进行评估。所有受试者年龄在18至40岁之间。由一名对多导睡眠图结果不知情的研究者进行19项头颅侧位测量。
对这19个变量进行单因素逻辑回归分析显示，阻塞性睡眠呼吸暂停组的面中部高度（ANS-N）显著增加、中气道间隙（MAS）变窄、下颌平面角（FMA）变陡、咽腔延长（PNS-Eb）以及舌骨位置下移（PNS-H、MP-H）。非呼吸暂停性打鼾组仅表现出上颌和下颌后缩（SNA和SNB）的趋势。颅底角（S-N-Ba）、PAS、下气道间隙、上颌单位长度（ANS-PNS）、下颌单位长度（Cd-Gn）、舌高度（Tng-Ht）、软腭长度（PNS-P）和腭穹窿高度（Ocl-Pal 6）未发现显著差异。还发现阻塞性睡眠呼吸暂停组的上、下咽均有多个异常部位，58%的患者有两个或更多异常值（比平均值高1个标准差），而非呼吸暂停性打鼾组为40%。
年轻阻塞性睡眠呼吸暂停患者的上、下咽存在高度显著的颅面异常。这些患者中的大多数（58%）上、下咽均有异常，这表明仅行腭部手术可能治疗不足。该信息可为确定如何更有效治疗这一亚组年轻阻塞性睡眠呼吸暂停患者所需的未来研究提供依据。
